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This past Friday, Monday, and Tuesday we spent time with the midwives of Carchá teaching them the same three topics that we taught the midwives in Chisec. That’s where the similarities end though. This group of midwives was vastly different from our first. There was a wider range of education to begin with, some couldn’t write or read and others who could read and write in multiple languages. There were women who were activists trying to fight for more rights for midwives. There was a mother of 19 who had delivered all of her babies herself – two of her daughters were there as midwives with her. There was a woman who had been a nurse for the government and changed to become a midwife.

I like to think that the six days we spent teaching these midwives has changed us all. We complain about salaries and hours and working conditions in the States, but it’s nothing compared to these women. They don’t get paid for anything that they do. They are on call 24/7. They don’t get vacations or sick leave. They walk at night for miles without lights to show them the way and then deliver babies on dirt floors by candlelight. I know they don’t have the same risk of malpractice – but they have a greater risk of maternal/fetal morbidity and mortality.

While I would like to say that all midwives in the States do what they do because they love it, I’d also like to think I’m not naive enough to believe that. The midwives here do this because they view it as a calling from a higher power. They do it for the love of their community and the love of their women. They do it in spite of constantly being put down by the government, of constantly being scorned, of constantly being waved off like they are unimportant – like they’re something less than others. I’m just in awe of them.

Teaching here was harder for all those who did it. We’re tired and languages are harder when your brain isn’t firing as sharply as it normally does. We all struggled to understand and to communicate. We struggled to accommodate the variety of educational levels. We struggled with illnesses taking out two of our more proficient speakers on the last two days. We struggled with patience for each other. It’s definitely been a harder go this time around on all fronts.

Part of the fun of international travel is always finding reliable internet connectivity. Since my last post I have been fighting quite aggressively with the internet and my computer, but finally I overcame (which is impressive if you knew how little I understand about computers). Anyway here is what I had typed up for day three and then some extra added to it to include days four and five (so it’s crazy long):

Afternoon storms are becoming a normal part of our routine – I think that they’re the only thing that actually runs on schedule here. Those of us who need internet, for homework or more leisurely activities like Netflix viewing, are watching the clouds and lightening roll in from the open, covered area where we get internet at this hotel. It’s making things significantly cooler here, which is such a blessing. The rainy season has begun in Guatemala, which means that the entire night was filled with rain falling on the tin roof of our room and that the entire day felt sticky and hot.

This morning, as the midwives started walking into the courtyard this bubble of excitement overwhelmed the table that where we were all sitting. We wanted so badly to go and greet them, and know them, and express our appreciation for them being there. Two issues with that desire: we didn’t want to overwhelm them and none of us speak their native language. Instead we settled for the traditional “Buenas días” and a pat on the arm/kiss on the cheek as they headed to our conference area.

Rebecca Gloss and Hannah Lake-Rayburn did the teaching today. The spent the entire morning dialoguing with the midwives about high blood pressure during pregnancy, preeclampsia, symptoms of these conditions, and when women were traditionally referred out. We then broke off into small groups and taught these midwives how to take blood pressures using the BP cuffs and stethoscopes we brought down for them. It was so exciting to realize how veracious these people are to learn new skills and about new equipment that they knew would help the women that they love so much.

Not that this teaching didn’t come without challenges: the majority of our group speaks some Spanish, but that becomes completely moot when trying to communicate with the majority of the midwives because they speak a traditional Mayan language that sounds and tastes nothing like Spanish. It’s harsher sounds, stronger syllables, thicker tongues. Luckily, we had a translator there, Maria, and quite a few of the midwives also spoke both, so in the end it all worked out from that standpoint. We were also educating a couple of illiterate individuals, which made taking blood pressures difficult for them because while they could hear the sounds and understand where on the monitor they needed to note numbers, they couldn’t dictate what the number actually was – which almost defeats the purpose. Our solution? Mark on the cuff monitor which pressures indicated an emergent situation and necessitated a referral. This job requires nothing if not adaptability.

After eating lunch with the midwives, they began there journeys back home – some of which would be more than two hours – and we returned back to our rooms for a quick siesta. At 1530, we met back up with one another and took the bus into the town of Chisec. We could hear and see the storm rolling in, but we were determined to get in a little bit of walking in spite of the obvious incoming weather. We paid for our stubbornness and got caught in a small shoe shop during a torrential downpour. All of the people who were in town took cover under something and we just watched the streets quickly fill with water. Luckily, the shop keepers were extremely pleasant and allowed us to stay under cover until Oswaldo came and picked us up in the bus.

The rest of the evening was spent putting together small packages for the midwives – consisting of gloves, umbilical ties (they don’t do clamps down here), new scissors to cut the umbilical cords with, sterile blue towels, and a couple of pairs of sterile gloves. All of these new goodies will provide the midwives with a very limited supply of some of the resources that they need – but we’re trying. These packages coincide beautifully with the educational session about sepsis and neonatal infections that will be conducted tomorrow by myself and Tamara Noy.

Our teaching went well. We got to have lengthy conversations about infections and how the midwives traditionally care for their women. I think at this point we were all quickly coming to the realization that these midwives are so so so knowledgable and so passionate. It becomes much more of a dialogue and much less teaching – an exchange of treatments and options and ideas. It’s so inspiring to learn from them and to hear what they go through on a daily basis.

We got to do a home visit with one of the comadrones, which was very eye-opening. The woman we saw five months pregnant with her fifth child. Her husband, her four daughters, and she lived in a building that is roughly the size of typical dorm room with dirt floors and a large curtain splitting off some of the sleeping areas from everything else. There were three chickens living in the house with them and a large (I mean large) bin of corn in one corner. Even though it was small, and the family was obviously impoverished, everything was clean and well-cared for – and the woman had pride showing us where she lived and introducing us to her daughters (all through the interpreter mind). We also got to see the return OB visit, the midwife did Leopold’s (basically felt the belly to determine the size and position of the fetus) and then did a mini rubdown of the woman’s legs and belly and arms – kind of like a massage. It was wonderful to see a midwife in another country utilize similar tools that we do in the States.

Finally, on Thursday, Chelsea and Michelle did their teaching on postpartum hemorrhage. They used chucks and poured different amounts of fake blood on to them to have the midwives determine which needed a referral and which was okay. We also supplied the midwives with headlamps and showed them how to use them so that they could see when they were walking in the middle of the night and check for tears in poorly lit buildings. Chelsea and Michelle mimed a birth with a postpartum hemorrhage and asked the midwives what they would do throughout. It was a very successful learning day.

We then went a stood in a circle with all of the comadrones and began throwing a ball of yarn from person to person. The person with the yarn would share what they had learned or what they enjoyed most about the past three days, would keep a hold of the string, and pass the ball along. At the end, we were all connected by this string which physically exemplified the way in which we were connected by our profession and our passion for the women that we get to care for on a regular basis. I think it’s safe to say that these three days in Chisec were inspiring and uplifting on both ends and just made me so much more excited to enter this profession.

Across Appalachia, coal miners are suffering from black lung in record numbers. There has been a major resurgence of the deadly disease, also known as coal worker’s pneumoconiosis. Miners develop black lung from breathing in coal dust. The dust particles settle in the lung where they cause inflammation and, eventually, fibrosis. Black lung causes shortness of breath, fits of coughing, and chronic bronchitis. It is progressive, incurable, and deadly. The Centers for Disease Control estimate that more than 76,000 Americans have died as a result of black lung since 1968.

Why the resurgence now? Many attribute the rise to changing mining practices. As the coal seams that are being mined shrink in size and become more difficult to reach, mining operations must break up more rock to get to the coal. The rock in these mountains contains high amounts of silica, which aerosolizes into very fine particles and is implicated in other fibrotic diseases of the lung. This may be the reason that case numbers of the most serious form of black lung have risen dramatically.

More miners are also coming to clinics for care. Although it is against the law to fire miners for getting chest x-rays or being diagnosed with black lung disease, many believe that if the mining company finds out that you’ve been tested–they’ll find a way to replace you. With the decline of the coal industry, more than 40,000 miners have lost their jobs since 2010 and six hundred mines have closed. Those laid-off miners are now coming in to clinics for care–and black lung diagnoses are sky-rocketing.

Here in Cabin Creek, The Breathing Center in Dawes, WV is a comprehensive pulmonary function facility with a rehab clinic and a federally approved Black Lung Center. The clinic provides pulmonary testing and rehabilitation, and a community-centered approach that allows people suffering from this difficult disease to come together and support each other. Importantly, the clinic also provides legal help to miners filing a claim for benefits under the Black Lung Benefits Act of 1973. This is a federal law that provides monthly payments and medical benefits to miners disabled by black lung. It’s an arduous process, so navigation help is critical. These benefits make a huge difference to the miners and their families.

Many in our group have able to spend time in the Breathing Center, learning about black lung and seeing patients in pulmonary rehab. This is a unique experience, as this disease is rarely seen outside of Appalachia. These miners worked very hard, in very dangerous settings, out of a necessity to provide for their family in a place with few other options. Getting to spend time with them is enlightening, and helps to illustrate the brutal legacy of occupational hazards endured in the pursuit of profit in this country.

Appalachian communities are among the hardest hit by the national opioid addiction epidemic. According to the Centers for Disease Control, West Virginia has the highest rate of drug overdoses in the country. Opioids are killing 40 people per 100,000 that use them in West Virginia–a truly staggering number. Here on the ground in the Cabin Creek Clinics, nearly every patient we have seen has been directly touched by opioid addiction in some way. We hear about it every day.

So why has West Virginia been hit so hard by this crisis? And what are health leaders here doing about it?

Today’s opioid epidemic is, in part, an unintended consequence of providers trying to better serve their patients. In the late 1990s and early 2000s, there was a push to improve treatment of patients with pain. Pain became known as the “fifth vital sign”, and a whole generation of providers was schooled in this new understanding of pain. This, of course, had good intentions. As providers, we want to be able to do something to alleviate pain for our patients. At the same time as this push for better pain management began, however, several new opioid drugs hit the market. Purdue Pharmaceuticals released OxyContin in 1996, billing it as a safer and less addictive opioid. This perfect storm of more varied and widely-available opioids entering the market (marketed aggressively as less-addictive and safer), and a call to more thoroughly treat pain or be seen as doing a disservice to your patient, is likely one of the primary reasons for the opioid epidemic. Today, more than a third of Americans are prescribed painkillers every year. Once a patient is hooked on these addictive meds (and they are highly addictive, despite misleading advertising from the drug companies), they often have to turn to buying opioids on the street to sustain their habit. It’s expensive to buy pills, so many switch to heroin. In most places, heroin goes for next to nothing–less than the cost of a six pack of beer. The rest, as the say, is history.

Much of the primary industry here in West Virginia is highly physical, dangerous work. Coal mines, oil rigs, and agriculture jobs often lead to injuries and physical aches and pains. These jobs can also be isolating and stressful. Many in these industries are considered working poor, living paycheck to paycheck under constant mental and emotional strain. Opioids don’t just help physical pain. They tend to numb the emotional and mental pain, too. In a place like Appalachia, for a myriad of reasons, there is plenty of all these kinds of pain to go around.

Most experts agree that addiction is a mental illness. Once someone is addicted, they will always have that addiction. So what can be done to help these folks break the habit?

Here in Cabin Creek, providers combine Medication Assisted Treatment or MAT, with an extensive behavioral health program. The MAT clinic, located in Kanawha City, provides methadone, suboxone, subutex and vivitrol to patients who are addicted to opioids. These medications help reduce cravings for opioids, which allows patients to remain in treatment and reap its benefits. Patients are required to attend weekly individual and group therapy to remain in the program. Therapy is key–the medication can treat the symptoms of addiction, but therapy helps people deal with the emotional and mental pain that keeps them using.

Many providers in primary care, including those at Cabin Creek, have pledged a more mindful approach to pain management, prescribing only short courses of opioids when absolutely necessary for trauma, and turning to other methodologies such as PT, massage, or NSAIDS for other types of pain. Further, Cabin Creek clinics are slowly weaning patients who have inappropriately been prescribed opioid pain medication, off of them and employing more proven modalities. This is a long and arduous process, but Cabin Creek clinicians believe it is critical to prevent potential addiction and abuse. Treating patients in a fast-paced clinic often means you only have time to prescribe a pill and send folks on their way. The opioid crisis is forcing prescribers to step back and reassess the long term damage they may be doing to their patients with this approach.

At Marshall Medical School here in West Virginia, medical students are receiving 30 hours of content on pain management in their first two years of medical school. Faculty believes that the earlier the exposure the better, and that the more providers understand the impact of opioids and see that impact in their training, the better able they will be to serve patients in this area.

I, for one, know that the West Virginia Cabin Creek rotation has given our group a first hand look in to this crisis. Several of us have actually gotten to work in the MAT clinic and see what these patients are going through. Pain is an issue for patients in every setting. We need to remain current on the evidence for how best to treat each condition, and remember the far reaching affects our choices will have.

West Virginian Word of the Day:

Pepperoni Roll (n.): A distinctly West Virginian food made of a soft white roll with pepperoni baked in the middle. It is the unofficial state food, found across the state, especially in convenience stores.

The School of Nursing’s Women’s Health program celebrated Class of 2016 graduates, current, and future students in a magical winter wonderland complete with plenty of sparkle, candle light, and snow.

Participants enjoyed the sites, sounds, and treats of the season, while competing in a tacky holiday sweater competition, posing in the holiday photo booth, and leaving messages and well-wishes for graduates and current students. The event was organized by Program Coordinator Trisha Sheridan.

On the evening before the Nell Hodgson Woodruff School of Nursing’s Winter Awards Ceremony, graduates look forward to the future.
Jasmine McCorkleWhy I chose Women’s Health:
I chose women’s Health because I have a passion for helping women. I was originally a labor and deliver nurse, but I would only see my patients for a brief period of time. With primary care I will be able to see them long-term and, hopefully, make a lasting impact on their lives.

Tiffanye Williams
Why I chose Women’s Health: I was a nurse for about 7.5 years and a travel nurse for about 4.5 years. I had some case management experience for about a year and a half. Throughout my career I discovered that I had a strong passion for helping women and wanted to specialize in Women’s Health.Plans after Graduation: Besides working…in the near future I would like to open my own clinic for women’s health.

Jenna Dannenbaum
Why I chose Women’s Health: I was a labor and deliver nurse prior to this in the Atlanta area. I am interested in increasing access to contraception for women and helping women be more educated about their bodies and make more informed decisions about their health throughout their lifespans.Plans after graduation: After graduation, I am hoping to work in a private practice setting under a good team of doctors whom I can collaborate with and show them what nurse practitioners have to offer.

Learn more about the Women’s Health Nurse Practitioner specialty from current students.

DAY 1| The bustling of the footsteps resonated throughout the Atlanta International Airport. All 16 of us arrived with high anticipation. Dr. Muirhead and Dr. Horigan, our two faculty instructors, directed as we quickly checked in eight packed suitcases of medical supplies and incentives (blood glucose monitors, gloves, band aids, hygiene kits, glasses, lotion, etc). We promptly started walking through TSA security with no concern or doubt that we would be stopped. However, we were completely wrong. Although most of us walked through smoothly, Dria (ABSN ’17) confidently knew that she would be stopped. “I just knew it,” she said as she shook her head after the incident. The red lights immediately flashed as her luggage passed through the security scanner. The TSA officer started searching through her personal items before pulling out the breast model she had for her breast self exam presentation. The officer’s eyebrows raised as she questioned, “what is this?” Without a second thought, Dria went nurse mode and preceded to educate her about breast exams. She even encouraged her to perform her own self exams and emphasized the importance of it. By the end of the conversation, Dria walked away with not only her breast model but also with the satisfaction about her premature patient education. We knew right then that this would be a good trip.

When we finally made it to Jamaica, we went straight to work. After refueling our energy with food, we took two hours packing first aid kits as incentives for our very first event! After designating leaders for this event, we headed over to The Church of God to speak with the individuals about the health related issues in Jamaica and Montego Bay.

Elianne Carroll (ABSN ’17) and Fauziya Ali (BSN ’17) created and executed the health module about the Zika virus. The ladies of the church listened intently as they followed them through their poster. In order to guide their understanding, we also provided them with an educational handout that had additional information to address any concerns.

After the presentation, we provided free blood pressure screenings and patient education. Dr. Muirhead floated around to assist and provided further patient education about actions individuals could take in order to help lower their blood pressure. Each participant received a gift bag with deodorant, anti-fungal cream, and their own personal first aid kit. The ladies and specifically the kids at the event enjoyed both the information and our presence.

We returned to the hotel in good spirits and hungry. After eating, debriefing, learning about hypertension education tips, and creating aromatherapy rice bags, we went straight to our rooms to say hello to our beds. FIRST DAY, SUCCESS.

Nursing is a rewarding and challenging field with dozens of specialties. Talented nurses hailing from thenation’s most prestigious nursing schools are able to find work in their field at hospitals and in doctors’ offices all over the country.

If you’re interested in choosing nursing for your career, your next step is to put together a strong application to impress the programs you’re interested in. Feeling nervous about getting it all done? Try these tips to get organized and successfully apply to top nursing schools.

1. Do Your Research

Before you apply, study up on what each program offers to make sure your preferred specialties, learning styles and locations are covered. You’ll also want to visit the campus to get a sense of what life there is like.

2. Apply to More Than One School

Rank your favorites, and apply to your personal top three to five programs. If you get accepted to more than one, you’ll be able to compare and contrast the programs and any financial aid packages to make an informed decision.

3. Apply Early

This is especially important if you’re looking at a program with a rolling admissions process — you don’t want all the spaces to be filled before you send in your application! Applying early gives the admissions committee time to consider your application and may give you a leg up on getting scholarship money. Scholarship awards are awarded generously to applicants who apply before the priority scholarship deadline.

4. Be Yourself

Admissions committees look to create diverse student bodies, so be sure to list all your previous jobs, extracurricular activities, volunteer work and any other unique leadership roles you’ve taken on. Let your personality shine through in your application. You can bring your application to life by giving the admission committee the chance to get to know you. Most schools offer Open Houses, Virtual Webinars, Facebook Chats, and Shadow Days. These are all excellent ways for you to get to know the school and for the school to get to know you.

5. Proofread

While showing off your unique style is a good thing, irregular spelling and grammar are not. Be sure to carefully edit and proofread your full application to avoid careless mistakes. These may be innocent, but they show a lack of attention to detail that points to a lack of effort — and a quick rejection.

Next Steps

As you research top nursing programs, be sure to check out Emory University’s Nell Hodgson Woodruff School of Nursing. Emory makes it easy to schedule a visit and learn more about its programs through information sessions. When you’re ready, try Emory’s new online applicationto the nursing program. It’s quick, it’s easy, and it takes less than 30 minutes to get started on your future today.

School of Nursing graduate students participate every year in a two-week immersion program in West Virginia through the Lillian Carter Center for Global Health and Social Responsibility. Our students work in partnership with area federally-qualified community health centers to promote health and prevent disease throughout the region. Led by faculty Advisors Carolyn Clevenger and Debbie Gunter, students Andrea Brubaker, Phillip Dillard, Kimberly Eggleston, Hannah Ng, Jill Peters, Allysa Rueschenberg, and Abigail Wetzel, were providing essential health services through four community clinics located in cities to the north and south of Charleston. Two of our students, Phil Dillard and Abby Wetzel, were working in a clinic in Clendenin, a town 25 miles northeast of Charleston that was hit hard by the storms.